By Patty Laushman
Many people who are looking for therapy for autistic adults find it difficult to locate and even more difficult to identify what works. Children diagnosed with autism or ADHD have numerous options for therapies and interventions to help them grow and thrive. Unfortunately, once you become a teen or adult, the options diminish significantly, but your challenges don’t necessarily disappear along with the options.
Many autistic adults I work with didn’t even discover they were autistic until their teens, twenties, or even later! They may either self-identify or get a formal diagnosis and think, “Great! I’m autistic. Now what?” They often feel like they missed the boat, but it’s not too late if you know where to look.
A diagnosis, whether self- or formal, is often a gateway to incredible self-understanding, self-acceptance, and ultimately self-advocacy, so you can thrive, but you may need a little help along that path from a team of people who “get” you and can help you optimize your quality of life.
Every neurodivergent person is different, but their challenges tend to cluster in certain areas of life. Below are therapies and interventions my life coaching clients have actually benefitted from. Perhaps they will benefit you too?
Mental Health Issues
If you are neurodivergent, there is a high likelihood you’ve required mental health services at some point during your life. The world was not built with you in mind, and everyday life is often a challenging minefield that can cause stress, anxiety, and even trauma for many neurodivergent people.
The unfortunate reality is that people going through licensure to work in the mental health field do not receive much training, if any, on neurodiversity. It’s just not possible to assume that anyone with a specific set of letters after their names will understand you or how to help.
Since general training programs are not doing a good job of training people in the mental health field on neurodiversity, the result is that many neurodivergent people often experience uninformed mental health counseling and psychiatry. At best they receive “help” that doesn't help (leaving them feeling more broken), or at worst, they experience “help” that is actually harmful, leaving them more stressed, anxious, and traumatized than they started.
Mental Health Counseling
If you have experienced medical and mental health trauma at the hands of uninformed professionals, you may not believe there is anyone who can help, but the reality is that a neurodiversity-affirming mental health practitioner is worth their weight in gold in helping autistic adults thrive. I cannot understate how helpful this can be if you find the right person.
I plan to write a whole blog post on this topic later, but for now, here are some quick tips for finding the right person for you:
Referrals are your best option. If you can find them, talking with other neurodivergent adults (or their parents) who have had success with an individual therapist is great. Autism life coaches also know who is effective. I'm regularly contacted just for therapist recommendations.
If money is tight, the Open Path Psychotherapy Collective has affordable, in-person and online psychotherapy sessions between $40-70. You can read individual bios to find someone who specializes in autism, ADHD, and other forms of neurodivergence.
Neurodivergent Therapist Directory is a website where therapists who cater to the neurodivergent population can list themselves. You can easily find the people licensed in your state.
PsychologyToday.com has a “Find a Therapist” section where therapists and coaches can list themselves and indicate any specializations. It’s convenient in that you can filter by state, insurance, and specific issues you would like someone to have expertise in, but it’s very much a "buyer beware" situation. Many people claim they specialize in autism or Asperger's, and they may actually believe this, but it may not be true. They may want to help, but they may not know what they don’t know. I recommend checking out their website and seeing what they say about themselves there. If their website doesn't have specific information about autism, ADHD, or neurodivergence, I would keep looking.
Psychiatry
Because the world was not built for them, and they struggle with many things other people do easily, many neurodivergent adults suffer from either periodic or chronic anxiety and depression. Many go on to develop post-traumatic stress disorder (PTSD) or complex post traumatic stress disorder (c-PTSD). When mental health counseling is not enough, medication may be helpful.
Unfortunately, many neurodivergent adults turn to self-medication to ameliorate their struggles. One study found that as many as 50 percent of autistic adults struggle with addiction at some point in their lives. This is particularly true in the case of neurodivergent adults who don’t have access to great health insurance, or they live remotely enough that they have trouble accessing the right providers. This can result in incomplete management of their symptoms and serious consequences, including addiction and even death.
Sometimes neurodivergent people end up with a series of incremental (but incomplete) and even incorrect diagnoses, which can lead to negative medication experiences. Autistic people may also respond differently to medications than neurotypical people which is why working with a psychiatrist who understands neurodiversity, who can provide correct diagnoses and make appropriate medication adjustments, is so critical.
When you find the right one, though, help from a skilled psychiatrist can have an astonishingly positive impact on your quality of life. They most commonly help neurodivergent clients with anxiety, depression, focus, and sleep. They can also help with other conditions that tend to overlap with autism like obsessive-compulsive disorder (OCD), bipolar disorder, and others. When these aspects of life are better under control, quality of life is improved.
It's important to know that demand for both therapists and doctors effective with the neurodivergent population far outstrips the supply, so they often have waitlists. Many of them also do not take insurance, so you will likely have to pay cash.
Sensory Issues
Many neurodivergent people struggle with senses that are hypersensitive (extremely sensitive) or hyposensitive (requires a lot of input to sense it). For example, many autistic people are very sensitive to loud noises, the textures of clothing, or smells in the environment.
They may also be hyposensitive to the sense of touch and crave deep pressure or benefit from weighted blankets on their lap while they work. As another example, a hyposensitive sense of interoception (the sense of signals that come from inside your body) may result in being unable to tell they are hungry, thirsty, or tired until it’s virtually an emergency.
This can have a massive impact on quality of life and ability to function in different environments!
An occupational therapist can help with this. They can help you figure out ways to reduce sensory inputs, adjust your environments to make them more tolerable, and otherwise mitigate the negative effects of having hyper- and hypo- sensory sensitivities.
Just make sure you ask questions in advance about whether the therapist has experience working with neurodivergent adults and is neurodiversity-affirming. You are not broken and in need of fixing. You just received a uniquely-wired brain and you may need some specialized instruction on how to operate with it optimally.
Social Issues
Group Social Skills Training
PEERS is a social skills training program developed by UCLA that has proven to have an extraordinarily positive impact on the relationships of autistic people who struggle to make and keep friends, date, and generally relate to others. Research shows that five years after graduating, 68 percent of participants are still having in-person get togethers with peers!
I use this curriculum in my one-on-one coaching with clients where relationships are part of their goals, but there is huge benefit to participating in the program with a group. If you are a teen or young adult aged 11-26 and cannot find a PEERS® group locally, check out this directory on the UCLA website listing certified providers around the world.
Fortunately, the program can be done online as well as in person. Their young adult groups are appropriate for people 18 and up, and there is no clear upper age limit for participants, so even if you are in your 30s or older, it’s worth checking out. Because it’s evidence-based, your health insurance may pay for PEERS if you have a formal diagnosis.
Do it Yourself Social Skills
If you are willing to try doing it yourself, the PEERS curriculum is available as a book, and there is a free app available as well.
Here is the book: The Science of Making Friends: Helping Socially Challenged Teens and Young Adults by Elizabeth A. Laugeson, PsyD: If you are struggling with the mechanisms of how to make friends, this is your book. Though the book targets parents of teens and young adults, the concepts are universal whether you are 19 or 99. The culmination of years of research, this evidence-based approach breaks down complex social behaviors into concrete, easy-to-understand rules and steps. Includes a DVD of examples. The videos are also available online.
Executive Functioning Issues
In my coaching experience, executive functioning issues are some of the most challenging skills to work on, but they also have equally amazing potential to improve quality of life.
For those who are unfamiliar with the term, executive functioning skills are a set of skills and behaviors that enable us to effectively and efficiently complete tasks and interact with others. They include things like planning, organizing, managing time, starting tasks, problem-solving, regulating emotions and impulses, and more.
Executive Functioning Coaching
The best intervention for developing executive functioning issues is one-on-one coaching with an autism life coach or executive functioning coach who is skilled in this area. The caveat with this is that there is no standard training path for coaches and no licensure that dictates what coaches need to know to call themselves executive functioning coaches.
Skills vary widely in this area, and so you need to screen a potential coach carefully. Ask if they use a particular curriculum, what their coaching process is, and how they help their clients stay accountable. If they don't have answers to these questions, it's probably best to keep looking.
Do it Yourself Executive Functioning Coaching
If you want to try to tackle it yourself, this is where I would start: a workbook co-authored by my friend, Chris Hanson. The Real-Life Executive Functioning Workbook: A Handbook of Exercises to Help Unique Learners Build Real-World Skills and Success.
While homeschooling my son, I spent years looking for something practical that I could use to explicitly teach executive functioning skills, and every other book I read left me feeling confused. I understood what executive functioning challenges were since I was living with them every day, but I had no idea how to help.
This book is so well designed, it can be used effectively by professionals and non-professionals alike. It includes an assessment so you can measure before and after functioning. For 50% off, use the code THRIVE50. (Note: I do NOT receive any sort of kickback on this).
Keep in mind that executive functioning skills are best developed in real life as part of achieving your specific goals. It would be unrealistic to think that you can sit and do some workbook exercises and suddenly thrive. The skills need to be applied to real life, and for this you may need help from a partner like a coach, parent, spouse, or friend.
Job/Career Issues
If you are struggling with any part of finding and keeping a job, your state's vocational rehabilitation (VR) office is definitely a resource you need to check out. You do not necessarily need a formal diagnosis to qualify; they will do their own assessment.
I must point out that it is hit or miss whether you will qualify and what level of services will be provided, but if you qualify, the services provided will be personalized to your individual needs. Since the purpose of the vocational rehabilitation program is to develop the state’s workforce, the services provided must be related to employment, but they can be quite broad.
I've had clients find this a total dead end because the counselor they were assigned did not understand their challenges related to neurodivergence. On the other end of the spectrum, I had a client for whom VR paid not only for my coaching, but also a driving assessment and one-on-one driving lessons with an occupational therapist, job search assistance, on-the-job coaching once she obtained employment to help her onboard successfully, and hands-on help getting her access to Medicare and other services.
To start the process, just Google "[your state] vocational rehabilitation" to find the website, and then look for how to contact your local office. Then don’t give up. It may take several phone calls to get a call back.
Challenges With Gaining Self-Sufficiency
The transition from being a high school student to college or career can be especially brutal for neurodivergent individuals. The expectations and skills needed to navigate this increase suddenly and exponentially. One day you're a high school student living at home, and the next day some people may be wondering why you're not working or going to school full-time or living on your own.
This is where Autism Independence Academy (AIA) can help. AIA is an intensive, eight-week virtual group coaching program for neurodivergent young adults (17-27) and their parent(s) who are looking to gain skills that will increase their self-sufficiency as an adult. We cover social skills, executive functioning, work/career, and confidence. The program includes four hours of coaching per week for the young adults and an hour for their parents. Then on Fridays we all meet together to celebrate the successes participants are having. You can schedule a complimentary consultation to explore whether this is a fit for your family here.
General Life Issues
I mentioned executive functioning coaching above, but this list would be incomplete without mentioning my own profession more broadly – life coaching.
Working with an autism life coach or more broadly a neurodivergent life coach who specializes in helping neurodivergent adults create the life they want can be a really impactful experience. A life coach can help you navigate the challenges that come with your neurodivergence and ultimately optimize your quality of life.
Here are some of the specific benefits of life coaching for neurodivergent adults:
Increased self-awareness: A life coach can help a neurodivergent adult better understand their strengths, challenges, and triggers. This increased self-awareness can help them develop better coping mechanisms and strategies to navigate difficult situations.
Improved social skills: Many neurodivergent adults struggle with social interactions and communication. A life coach can help them develop strategies to improve their social skills and build stronger relationships if this is part of their goals.
Improved executive functioning: Many neurodivergent adults struggle with executive functioning skills, such as organization, time management, and decision-making. A life coach can help them develop strategies to improve these skills and better manage their daily lives.
Goal-setting and achievement: A life coach can help a neurodivergent adult identify their goals and develop a plan to achieve them. This can be especially helpful for those who struggle with prioritization and decision-making. The life coach then helps them execute the plan step-by-step, leveraging strengths and mitigating challenges.
Reduced anxiety and stress: Life coaching can help a neurodivergent adult better understand and manage their anxiety and stress levels. A coach can help them identify tools and strategies that reduce anxiety and stress in their daily lives.
As I mentioned in the executive functioning section, since there is no established training path or licensure that dictates what someone needs to know before they can hang a shingle and call themself a life coach, it’s very important to screen someone carefully to make sure they have the skills needed to help you achieve your goals for coaching so you don’t waste your time or money.
Skill levels vary widely. Some autism life coaches specialize in different areas such as the high school-to college transition or neurodiverse relationships. Others like me work as generalists covering social skills, executive functioning skills, education, career, and everyday living.
Look into their training and make sure they have done something related to neurodiversity. Ask how they approach working toward the kinds of goals you are considering working on. Ask about their approach to working with clients. Consider asking to talk to others they’ve helped with similar goals. They should offer a complimentary phone call where you can get a pretty clear idea of what it would be like to work with them.
Conclusion
While finding providers who understand autism and neurodiversity can be a challenge, there are quite a few options for effective therapy and interventions for autistic adults that can have a major impact on improving quality of life and enabling them to live their best lives.
It is essential to find therapists and coaches who are experienced in working with neurodivergent adults and who are neurodiversity-affirming. With specialized instruction and support, autistic adults can achieve their goals and thrive.